使用脂蛋白颗粒指标评估美国心脏协会/美国心脏病学会指南发布后的冠心病风险：动脉粥样硬化的多民族研究。
Use of lipoprotein particle measures for assessing coronary heart disease risk post-American Heart Association/American College of Cardiology guidelines: the Multi-Ethnic Study of Atherosclerosis.
机构信息
From the Department of Laboratory Medicine and Pathology (B.T.S., M.Y.T.) and Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis; Department of Laboratory Medicine, National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.); University of Washington School of Medicine, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle (P.P.); Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health (S.R.H.) and Department of Biostatistics (R.L.M.), University of Washington, Seattle; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); and Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (E.D.M.).
出版信息
Arterioscler Thromb Vasc Biol. 2015 Feb;35(2):448-54. doi: 10.1161/ATVBAHA.114.304349. Epub 2014 Dec 4.
OBJECTIVE
The American College of Cardiology and American Heart Association have issued guidelines indicating that the contribution of apolipoprotein B-100 (ApoB) to cardiovascular risk assessment remains uncertain. The present analysis evaluates whether lipoprotein particle measures convey risk of coronary heart disease (CHD) in 4679 Multi-Ethnic Study of Atherosclerosis (MESA) participants.
APPROACH AND RESULTS
Cox regression analysis was performed to determine associations between lipids or lipoproteins and primary CHD events. After adjustment for nonlipid variables, lipoprotein particle levels in fourth quartiles were found to convey significantly greater risk of incident CHD when compared to first quartile levels (hazard ratio [HR]; 95% confidence interval [CI]): ApoB (HR, 1.84; 95% CI, 1.25-2.69), ApoB/ApoA-I (HR, 1.91; 95% CI, 1.32-2.76), total low-density lipoprotein-particles (LDL-P; HR, 1.77; 95% CI, 1.21-2.58), and the LDL-P/HDL-P (high-density lipoprotein-P) ratio (HR, 2.28; 95% CI, 1.54-3.37). Associations between lipoprotein particle measures and CHD were attenuated after adjustment for standard lipid panel variables. Using the American Heart Association/American College of Cardiology risk calculator as a baseline model for CHD risk assessment, significant net reclassification improvement scores were found for ApoB/ApoA-I (0.18; P=0.007) and LDL-P/high-density lipoprotein-P (0.15; P<0.001). C-statistics revealed no significant increase in CHD event discrimination for any lipoprotein measure.
CONCLUSIONS
Lipoprotein particle measures ApoB/ApoA-I and LDL-P/high-density lipoprotein-P marginally improved net reclassification improvement scores, but null findings for corresponding c-statistic are not supportive of lipoprotein testing. The attenuated associations of lipoprotein particle measures with CHD after the adjustment for lipids indicate that their measurement does not detect risk that is unaccounted for by the standard lipid panel. However, the possibility that lipoprotein measures may identify CHD risk in a subpopulation of individuals with normal cholesterol, but elevated lipoprotein particle numbers cannot be ruled out.
目的
美国心脏病学会和美国心脏协会已发布指南，表明载脂蛋白 B-100（ApoB）对心血管风险评估的贡献仍不确定。本分析评估脂蛋白颗粒测量值在 4679 名动脉粥样硬化多民族研究（MESA）参与者中是否与冠心病（CHD）的风险相关。
方法和结果
采用 Cox 回归分析确定血脂或脂蛋白与原发性 CHD 事件之间的关系。在调整非脂质变量后，与第一四分位数相比，第四四分位数的脂蛋白颗粒水平与更大的 CHD 发病风险相关（风险比[HR]；95%置信区间[CI]）：ApoB（HR，1.84；95%CI，1.25-2.69），ApoB/ApoA-I（HR，1.91；95%CI，1.32-2.76），总低密度脂蛋白颗粒（LDL-P；HR，1.77；95%CI，1.21-2.58）和 LDL-P/高密度脂蛋白-P（HDL-P）比值（HR，2.28；95%CI，1.54-3.37）。在用美国心脏协会/美国心脏病学会风险计算器作为 CHD 风险评估的基线模型进行调整后，ApoB/ApoA-I（0.18；P=0.007）和 LDL-P/HDL-P（0.15；P<0.001）的净重新分类改善评分显著降低。C 统计数据显示，任何脂蛋白测量值均未显著提高 CHD 事件的区分度。
结论
脂蛋白颗粒测量值 ApoB/ApoA-I 和 LDL-P/HDL-P 略微提高了净重新分类改善评分，但相应的 C 统计数据没有显著增加，不支持脂蛋白检测。在调整脂质后，脂蛋白颗粒测量值与 CHD 的关联减弱表明，其测量并不能检测到标准脂质谱无法解释的风险。然而，脂蛋白测量值可能在胆固醇正常但脂蛋白颗粒数量升高的个体亚群中识别 CHD 风险的可能性不能排除。
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